Long-term outcomes in patients with polyarticular juvenile idiopathic arthritis receiving adalimumab with or without methotrexate

Objectives Long-term safety and efficacy of adalimumab among patients with juvenile idiopathic arthritis (JIA) was evaluated through 6 years of treatment. Methods Children aged 4-17 years with polyarticular JIA were enrolled in a phase III, randomised-withdrawal, double-blind, placebo-controlled trial consisting of a 16-week open-label lead-in period, 32-week randomised double-blind period and 360-week long-term extension. Patients were stratified by baseline methotrexate use. Adverse events (AEs) were monitored, and efficacy assessments included JIA American College of Rheumatology (JIA ACR) 30%, 50%, 70% or 90% responses and the proportions of patients achieving 27-joint Juvenile Arthritis Disease Activity Score (JADAS27) low disease activity (LDA, = 6 continuous months) during the study. Attainment of JIA ACR 50 or higher and JADAS27 LDA or ID in the initial weeks were the best predictors of clinical remission. Mean JADAS27 decreased from baseline, 22.5 (n=170), to 2.5 (n=30) at week 312 (observed analysis). Conclusions Through 6 years of exposure, adalimumab was well tolerated with significant clinical response (up to clinical remission) and a relatively low retention rate

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

Environmental Influences on Frozen Epididymal Sperm Cell Viability in White-Tailed Deer

The objective of this study was to evaluate the association between Temperature and Humidity Index (THI), age, and post-collection time with post-thawing sperm cell parameters such as progressive motility, viability, morphology, and cytoplasmic droplets. Samples were collected from 4 male white-tailed deer after regulated hunting. THI was calculated on collection days. Two THI categories were determined, ≥70 and &lt;70. Thawed semen was placed on a slide and observed under a phase-contrast microscope to evaluate the progressively motile sperm cells. Morphology, viability, and cytoplasmic droplets were assessed on a smear stained with eosin-nigrosine and classified as normal or abnormal, viable or not viable, and present or absent, respectively. When THI was ≥70, the progressive motility (51.0 vs 30.67%), sperm viability (51.0 vs 36.33%), and the proportion of sperm cells with normal morphology (65.0 vs 37.67%) were higher than to days with a THI &lt;70, without differences in the presence of cytoplasmic droplets. The 4-years bucks had a higher proportion of sperm cells with normal morphology (81.0 vs 35.5 and 26.0%) and cytoplasmic droplets (27.0 vs. 12.0 and 7.5%) compared to 2- and 3-year-old animals. Samples processed after 4 hours (51.0%) had a higher progressive motility than samples processed after 6 and 8 hours (32.0 and 25.0%, respectively). Spermatozoa processed after 8 hours (30.0%) had a lower viability than spermatozoa processed after 4 hours (51.0%). Compared to samples processed after 6 and 8 hours, those processed after 2 and 4 hours had a higher proportion of sperm cells with normal morphology (26.0 and 6.0 vs 81.0 and 65.0%, respectively). Samples processed after 2 hours had a higher (27.0 vs. 12.0%) proportion of sperm cells with cytoplasmic droplets than to those processed after 6 hours. High THI favors progressive motility and sperm viability. The older bucks had a greater proportion of sperm cells with normal morphology and cytoplasmic droplets than to the young ones. The greater progressive motility, viability, morphology, and presence of cytoplasmic droplets were found when the samples were processed within the first 4 hours

Association between metabolic and immunological changes during the transition period of dual-purpose cows in the Veracruz tropic, Mexico

The objective of this study was to identify changes and associations in body condition score (BCS), serum glucose and β-hydroxybutyrate (BHB) concentrations, and white blood cell populations in dual-purpose cows during the transition period in the Veracruz tropic. BCS was evaluated and blood samples were taken weekly to determine white blood cell populations, serum glucose and BHB concentrations of 30 multiparous dual-cows (Bos taurus × Bos indicus) from 3 weeks before the expected date of calving to 3 weeks postpartum. During the prepartum period, BCS (3.56 vs 3.11 points), leukocytes (8.964 vs 7.032 × 103 cells µL-1), neutrophils (3.353 vs 2.201 × 103 cells µL-1), lymphocytes (4.750 vs 4.051 × 103 cells µL-1), and monocytes populations (222 vs 126 × 103 cells µL -1) were higher compared to the postpartum period. Contrarily, BHB concentration was higher in the postpartum period (1.34 vs 0.84 mmol L-1) than in the prepartum period. No differences in basophils and eosinophils populations and glucose concentration were identified. Associations between BCS, BHB, glucose, and populations of neutrophils, monocytes, and basophils were detected. The higher BCS, the higher the monocyte population (r = 0.22). The lower the glucose concentration, the higher the BHB concentration (r = −0.51). The higher the concentration of BHB, the lower the number of neutrophils (r = −0.22), monocytes (r = −0.32) and basophils (r = −0.23). In conclusion, low-producing dual-purpose cows experienced fluctuations in BCS, BHB, and immune cell populations during the transition period, suggesting similar metabolic and immune changes as in high-producing dairy cows

Treatment Satisfaction, Patient Preferences, and the Impact of Suboptimal Disease Control in a Large International Rheumatoid Arthritis Cohort: SENSE Study

Background: Patients' needs and perspectives are important determinants of treatment success in rheumatoid arthritis (RA). Assessing patients' perspectives can help identify unmet needs and enhance the understanding of treatment benefits. ----- Objective: The SENSE study assessed the impact of inadequate response to disease-modifying antirheumatic drugs (DMARDs) on treatment satisfaction, disease outcomes, and patient perspectives related to RA disease management. ----- Methods: SENSE was a noninterventional, cross-sectional study conducted in 18 countries across Europe, Asia, and South America. Adult patients with poorly controlled RA of moderate/high disease activity were eligible. Patient satisfaction was assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM v1.4). Treatment adherence, healthcare resource utilization (HRU), quality of life (QoL), work ability, digital health literacy (DHL), patient preference information, and treatment strategy were also assessed. ----- Results: A total of 1624 patients were included in the study: most were female (84.2%) and middle-aged, and mean disease duration was 10.5 years. Mean TSQM global satisfaction subscore was 60.9, with only 13.5% of patients reporting good treatment satisfaction (TSQM global ≥80). The strongest predictor of good treatment satisfaction was treatment with advanced therapies. Most patients (87.4%) reported good treatment adherence. In general, patients had impaired QoL and work ability, high HRU, and 67.4% had poor DHL. Leading treatment expectations were "general improvement of arthritis" and "less joint pain". Most patients preferred oral RA medications (60.7%) and rapid (≤1 week) onset of action (71.1%). "Increased risk for malignancies" and "increased risk for cardiovascular disease" were the least acceptable side effects. Despite suboptimal control, advanced therapies were only used in a minority of patients, and DMARD switches were planned for only half of the patients. ----- Conclusion: Suboptimal disease control negatively impacts treatment satisfaction, work ability, QoL, and HRU. Data collected on patient perspectives may inform shared decision-making and optimize treat-to-target strategies for improving patient outcomes in RA

Long-term outcomes in patients with polyarticular juvenile idiopathic arthritis receiving adalimumab with or without methotrexate

OBJECTIVES: Long-term safety and efficacy of adalimumab among patients with juvenile idiopathic arthritis (JIA) was evaluated through 6 years of treatment. METHODS: Children aged 4-17 years with polyarticular JIA were enrolled in a phase III, randomised-withdrawal, double-blind, placebo-controlled trial consisting of a 16-week open-label lead-in period, 32-week randomised double-blind period and 360-week long-term extension. Patients were stratified by baseline methotrexate use. Adverse events (AEs) were monitored, and efficacy assessments included JIA American College of Rheumatology (JIA ACR) 30%, 50%, 70% or 90% responses and the proportions of patients achieving 27-joint Juvenile Arthritis Disease Activity Score (JADAS27) low disease activity (LDA, ≤3.8) and inactive disease (ID, ≤1). RESULTS: Of 171 patients enrolled, 62 (36%) completed the long-term extension. Twelve serious infections in 11 patients were reported through 592.8 patient-years of exposure. No cases of congestive heart failure-related AEs, demyelinating disease, lupus-like syndrome, malignancies, tuberculosis or deaths were reported. JIA ACR 30/50/70/90 responses and JADAS27 LDA were achieved in 66% to 96% of patients at week 104, and 63 (37%) patients achieved clinical remission (JADAS27 ID sustained for ≥6 continuous months) during the study. Attainment of JIA ACR 50 or higher and JADAS27 LDA or ID in the initial weeks were the best predictors of clinical remission. Mean JADAS27 decreased from baseline, 22.5 (n=170), to 2.5 (n=30) at week 312 (observed analysis). CONCLUSIONS: Through 6 years of exposure, adalimumab was well tolerated with significant clinical response (up to clinical remission) and a relatively low retention rate.status: publishe

Memorias II congreso internacional de investigación "San Martín Investiga" 2021

El Congreso internacional San Martín Investiga, es un espacio de discusión sobre los avances en el campo de la salud y la educación. Permite a investigadores de distintas nacionalidades dialogar sobre sus avances de investigación. Como espacio abierto, se presentan las memorias del evento en idioma español e inglés para un intercambio abierto con la comunidad académica mundial. Se aclara que la Fundación Universitaria San Martín no se hace responsable por los conceptos emitidos por los investigadores en sus trabajos y que cualquier inquietud puede ser remitida a los autores. The International Research Congress San Martín Investiga is a space for discussion on advances in the field of social science and health science. It allows researchers of different nationalities to discuss their research advances. As an open space, the proceedings of the event are presented in Spanish and English for an open exchange with the world academic community. It is clarified that the Fundación Universitaria San Martin is not responsible for the concepts issued by the researchers in their work and that any concerns can be referred to the authors